MSCM Student Karina Quiroz Addresses Oral Health Disparities Among American Indian/Alaskan Native Populations in APHA Presentation

Keck Graduate Institute (KGI) student Karina Quiroz, MSCM ’23, offered solutions to oral health disparities among Indian/Alaskan native populations in her presentation, “Addressing Oral Health Disparities in the American Indian/Alaskan Native (AI/AN) Community with Traditional Medicine Wheels.” She presented as part of a round table discussion for the American Public Health Association (APHA) on October 25.

As a member of KGI’s inaugural cohort in the brand-new Master of Science in Community Medicine (MSCM) program, Quiroz has actively researched health disparities within different communities to make a case for greater health equity ever since enrolling at Cal State LA, where she earned a bachelor’s in Public Health in 2020.

The impact of colonialism through genocide and removal from traditional land continues to be felt in AI/AN populations, who suffer the worst oral health outcomes compared to other racial and ethnic groups in the United States. AI/AN children have the highest level of tooth decay and are nearly three times more likely to have early childhood caries than white children.

Quiroz has also investigated community interventions that specifically target oral health to inform her future practice as a public health dentist. One project examined the intersection of tobacco use, mental health, and oral health.

“Even though oral health is definitely my niche and something that I take a lot of joy in, I’ve tried to practice outside of the silo and see how different projects and disciplines can connect with oral health,” Quiroz said.

During her time at Cal State LA, Quiroz began as a student intern and progressed into the role of a research team leader for Educational Community Health Outreach (ECHO), a program that promotes the oral health of Los Angeles children and youth in underserved areas through dental screenings, education, service coordination, and community outreach. Here she gained valuable field experience and began working with the AI/AN population.

“That was a great way to build community capacity, and we were really able to make a difference in many of the dental deserts of LA county,” Quiroz said.

Her work with ECHO informed her APHA presentation, which focused on developing oral health education materials for urban indigenous youth in a culturally relevant way that acknowledges a holistic view of health. To this end, Quiroz and her team presented an oral health medicine wheel tailored to the different life stages of birth, youth, adult, and elder.

For each stage, the wheel explains common dental changes that can occur along with recommendations for dental care. For example, youth are encouraged to follow the 2-2-2 Rule: brushing and flossing twice a day, brushing for two minutes each time, and seeing a dentist twice a year.

The wheel also has an interactive element, facilitating intergenerational discussions through leading questions such as, “How old were you the first time you saw a dentist?” Children have a space where they can illustrate the story of their smile.

Some challenges that arose during the project were a lack of literature on oral health among AI/AN populations and insufficient options for artwork to include on the medicine wheel, as many stock photos contained only stereotypical images. To address the latter, Quiroz and her team are working with these communities to create their own original artwork.

When it comes to the larger issue concerning lack of dental care in these areas, solutions include simple preventative oral health measures such as the brushing and flossing tips mentioned in the educational materials as well as offering more services by dental therapists, who can care for patients under the supervision of a licensed dentist. Such practitioners enable these communities to offer more treatments without increasing the amount of dentists within clinics.

“These services have really helped to make quality dental care more accessible in rural communities,” Quiroz said.

Quiroz also presented to APHA on “Using Caution Sidewalk Signs in COVID-19 High-Risk Neighborhoods in Los Angeles County.” In her presentation, she describes how she and her colleagues distributed sidewalk signs in these neighborhoods encouraging residents to take safety measures such as wearing masks, washing hands, and using physical distance.

The signs also provide information on free tests and vaccinations. Upon the completion of the project, they found that COVID-19 cases had decreased more than three-fold based on 14-day cumulative case trends in three of the four high-risk communities where the intervention took place (Pico Union, Highland Park, and Lincoln Heights).

During the first semester of KGI’s MSCM program, Quiroz has enjoyed stimulating class discussions.

“It’s great to be surrounded by so many inspirational, highly motivated, like-minded individuals,” Quiroz said. “That’s my favorite part of the program—being amongst stellar scholars.”

“Their motivation and drive is definitely contagious. Our professors really care about our performance and make the extra effort to support us in working out our schedules, since it is a virtual setting.”

Quiroz also appreciates the passion that Founding Program Director and Professor of Practice Dr. Monique J. Williams brings to the table.

“She’s so articulate and a great champion of finding solutions for health disparities,” Quiroz said. “She’s also very inspirational. It can be easy to lose momentum in a virtual program, but our program stands apart in the sense that we all get fired up.”

Quiroz plans to attend dental school after completing the MSCM program. No matter where her future takes her, though, she will continue to advocate for and contribute to the development of a more equitable healthcare system.